Environment Can Mitigate Empathy in Nursing Home Residents

Researchers have discovered that living in a stimulating environment can reduce apathy among demented nursing home residents.

Nearly half of all residents in nursing homes have dementia, according to a 2013 report by the Centers for Disease Control.

Apathy is one of the most common neurobehavioral symptoms in dementia, with about 90 percent of older adults with dementia experiencing it. Those with mild dementia will decline more quickly into severe dementia if they also suffer from apathy, making it important to help them stay engaged.

“Persons with dementia who are also apathetic won’t be curious about the world around them; they are not motivated to carry out activity nor engage with those around them, in either a positive or a negative way,’ said Ying-Ling Jao, assistant professor of nursing, Pennsylvania State.

“Apathy has several negative consequences for both the persons with dementia and their caregivers. The individuals’ cognitive function will likely decline faster and their caregivers will have more difficulty with their caregiving and are more likely to become depressed.”

In the study, Jao observed 40 nursing home residents with dementia by watching video recordings of each taken throughout a typical day. She chose three videos per resident from recordings made during a previous study — one taken at a mealtime, one during a direct interaction between the resident and staff and one that was randomly selected.

“The purpose of this study was to examine the relationship between environmental characteristics and apathy in long-term care residents with dementia,” said Jao.

“My interest in apathy was mainly driven by my clinical observations in nursing homes when I was a nurse practitioner student. I remember that no matter which nursing home I visited, I often saw a crowd of residents sitting in the living room or hallway with no interest in the surroundings and no emotional expression.”

The study is published in the current issue of The Gerontologist.

Jao looked at five characteristics in particular: environmental stimulation, ambiance, crowding, staff familiarity, and light and sounds. Of the five, clear and strong environmental stimulation was the most significantly associated with a lower apathy level in the residents.

“Interestingly, our results showed that clear and strong environmental stimulation is related to lower apathy, while no stimulation or an overwhelming environment with no single clear stimulation is related to higher apathy,” the researchers said.

Investigators explain that clear stimulus is found in an environment without competing background noise, and with a single straightforward stimulus. A good example of this is a therapist leading a music therapy program for residents in an otherwise quiet room.

The strength of the stimulus depends on how intense, persistent, interesting, and out of the ordinary it is. Routine activities, such as a regular conversation or meal, are considered moderate stimulation, while a birthday party is considered strong simulation.

“One of the innovative features of this study is that we used the Person-Environment Apathy Rating scale to measure environmental stimulation at an individual level,” said Jao.

“I believe that the same stimulation may be perceived differently or bring about different responses for different individuals in the same environment based on the individual’s characteristics, interests and relevance to the stimulation.

“In fact, a stimulus may be clear to one person but unclear to another because of differences in hearing or visual abilities, especially in older adults.”

Jao plans to continue this research by replicating the study with a larger sample size and by looking more closely at the quality of interaction and communication between nursing home residents and their caregivers.

“One of the most important implications of these findings is that they will guide us in designing appropriate physical and social environments for dementia care that helps prevent or decrease apathy,” she said.

“We need more people to care about apathy for older adults with dementia.”

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Rick Nauert PhD

Dr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.